Prof. Srinath Reddy

Q: In the CVD report, you cite a statistic that shows CVD mortality has risen 40% globally in the past 25 years. Why is that?

Srinath Reddy: This is for both good reasons and bad reasons. The good reasons are that life expectancy in general has increased all over the world, so if people live longer and die less from competing causes of death like infectious diseases, which kill them young, then they are more likely to be exposed to risk factors of cardiovascular disease for a longer time and therefore cardiovascular disease increases in populations as they age. The bad reason is that as a result of multiple factors such as industrialization, urbanization and globalization, living habits have altered and therefore people are more likely to consume unhealthy diets in larger quantities. They are likely to exercise less. Tobacco is being sold aggressively, particularly in low and middle income countries, and stress levels are increasing. So there are variety of factors which are now causing people to be at a greater risk for a longer period of time and therefore the likelihood of falling victim to cardiovascular disease is much higher now than it was about 40 or 50 years ago.

Q: Why do you think CVD is one of the world’s most pressing healthcare issues?

Srinath Reddy: Cardiovascular disease is the number one killer globally. It kills about 17.5 million people each year and this is rising every year. About 80 per cent of all deaths caused by CVD in the world are in low and middle income countries. What is even more worrisome is the fact that 40 per cent of these deaths are below the age of 70 years, in the productive prime of life. Ninety per cent of those premature deaths are in low and middle income countries. So there is a huge impact on the economic productivity of countries as well as on family fortunes where the wage earner dies and the family is pushed into poverty.

Q: What are the main factors of CVD?

Srinath Reddy: We now know that the major contributors to cardiovascular disease are tobacco, unhealthy diet, physical inactivity, immoderate consumption of alcohol, as well as stress. There are a number of other factors but most of them can be encapsulated in these risk factor complex.

Q: What area should policy makers focus on to improve CVD prevention and can you share a couple of examples of those areas?

Srinath Reddy: Firstly, we are looking at risk being reduced all across the lifespan, from the time a baby is born and exposed to unhealthy foods or even the tobacco smoke from a mother or father, until the last stage where an elderly person requires support after having had a cardiac problem. Policymakers must now provide an array of interventions that focus firstly on improving population health and protecting them from exposure to harmful factors as well as measures to deter the marketing of unhealthy food or tobacco products for example. Those all come under what we call non-personal interventions which have a population wide impact.

The policy makers have to first provide a strong policy environment which is conducive to maintain healthy choices of diet, physical activity, staying away from tobacco and so on. At the same time, they ought to be able to create and maintain a strong health system which is readily responsive to the needs of different people at different levels of risk.

Q: How can investing in CVD prevention help have better outcomes beyond health benefits?

Srinath Reddy: Firstly, investing in CVD prevention and control will have a lot of health benefits beyond CVD and it will have non-health benefits as well. For example, if you control tobacco, improve healthy diets and improve physical activity, a large number of cancers can be prevented.

Beyond health benefits, there are environmental benefits as well. If you are encouraging physical activity by creating community spaces like areas for physical activities that restrict motor vehicle use, you are protecting the environment. Most importantly, if you implement tobacco control, you are preventing the wage earner of a family from dying an early death. That way you ensure children are not deprived of education, nutrition and wellbeing. The death of a wage earner can have a catastrophic effect on a family, pushing them into poverty.

Q: What are the specific policy implications? And how can policy makers be convinced to implement them, and how can the public be convinced of them?

Srinath Reddy: I think it is important for the policy makers to first recognize the reality of this threat. It is now a mass epidemic. It affects every section of society. The poor are increasingly more vulnerable than the rich. So on the grounds of equity as well as protecting economic productivity and reducing mounting healthcare costs, policy makers have to act now, otherwise the cost of inaction is going to be huge and healthcare cost will escalate beyond the capacity of any government to control or contain.

Q: What do you like about participating in WISH forum with this group of people and on this platform?

Srinath Reddy: I think it is absolutely important to prevent death and disease which is eminently avoidable. We have the knowledge of what causes the disease and what are the factors, and the knowledge of how effective interventions can be if properly applied. So it becomes our duty now to ensure that this knowledge is translated into actions and action results in impact and that impact is also reflected in health equity.

Q: What do find personally rewarding about this work that you do?

Srinath Reddy: I think it is absolutely important to prevent death and disease which is eminently avoidable. We have the knowledge of what causes the disease and what are the factors, and the knowledge of how effective interventions can be if properly applied. So it becomes our duty now to ensure that this knowledge is translated into actions and action results in impact and that impact is also reflected in health equity.

Q: What is the influence that you hope to achieve through WISH?

Srinath Reddy: Much of the knowledge of cardiovascular disease is within the academic research community or among the health professionals. It has not widely percolated to the wider community and certainly has not appeared prominently on the radar screen of global policy makers during the time of priority setting and resource allocation. We believe that the WISH forum offers us a great opportunity to project the real threat of cardiovascular disease as well as a great opportunity to alert the policy makers so they start prioritizing actions in this area.